Medicaid policy and related barriers to employment for Vocational Rehabilitation clients in North Carolina

The Center for Medicare and Medicaid Services has identified several concerns that limit employment of adults with disabilities: 1. Low expectations, 2. Segregation of individuals with disabilities and the services provided to them into 'programmatic silos,' 3. Contradictory messages that label individuals as disabled (defined as unable to perform significant work) and then seek to encourage employment, and 4. Complexity of the service system. Little information exists that describes these issues across disabilities. Data from a state-wide survey (n=292) of Vocational Rehabilitation clients in North Carolina conducted in 2006 describe facilitators and barriers to employment by disability. Findings provide a detailed description of current and past work and how this was related to program participation, personal assistance needs, and fears and interest in work changes and new Medicaid programs. In NC, 45% of clients have a primary disability that is physical, 29% cognitive, and 26% psychosocial. On average, 39% of clients were currently working: 36%, 46%, and 43% among the three groups respectively. Findings confirm that program participation is segregated into NC's divisions for the blind, deaf and mental health and developmental disabilities. However, participation rates in general programs such as Medicaid, Social Security and Vocational Rehabilitation were similar. One quarter of clients were deemed disabled by Social Security and were also seeking to increase employment. Individuals with physical and psychosocial disabilities were more likely to express fear about losing benefits due to employment. Findings serve to dispel myths as well as target groups needing more attention from policymakers.